Is Fragmentation of Prostate Core Biopsies Inevitable?: A Quality Improvement Initiative.

Area of Science:

• Urology
• Pathology
• Cancer Diagnosis

Background:

• Prostate cancer diagnosis relies on core biopsies.
• Biopsy fragmentation poses challenges for accurate cancer assessment and staging.
• Accurate staging is critical for effective prostate cancer management.

Purpose of the Study:

• To identify factors contributing to prostate biopsy fragmentation.
• To evaluate the impact of specimen handling on biopsy integrity.

Main Methods:

• Prospective identification of prostate core biopsies from two hospital sites.
• Analysis of specimen handling: number of cores per jar and mounting method (Telfa pad vs. free suspension).
• Definition of fragmentation as the discrepancy between submitted and microscopically counted cores.

Main Results:

• Overall fragmentation rate was 29.3% across 535 specimen jars.
• Submitting more than one core per jar significantly increased fragmentation (41% vs. 14%).
• Telfa-mounted cores showed higher fragmentation, especially when multiple cores were present (46% for 3 mounted cores vs. 19% unmounted).

Conclusions:

• Increased fragmentation is associated with submitting multiple biopsy cores per jar.
• The use of Telfa pads for mounting also contributes to higher fragmentation rates.
• Recommendations include submitting one core per jar and avoiding Telfa mounting to improve specimen quality.